Hydroxychloroquine Use in Rheumatoid Arthritis and Chronic Kidney Disease

Introduction to Hydroxychloroquine Therapy

• The American College of Rheumatology recommends hydroxychloroquine use in patients with rheumatoid arthritis and chronic kidney disease, as it is associated with a significantly lower risk of incident CKD development and is generally safe with appropriate dose adjustment for renal function 1.

Dosing and Renal Considerations

• The standard dose of hydroxychloroquine is ≤5.0 mg/kg/day based on actual body weight, which provides a low toxicity risk, with fewer than 2% developing retinopathy after 10 years of use 1.
• For patients with eGFR <30 ml/min/1.73m², the dose should be reduced by 25% 2, 3, 4, 5.

Ophthalmologic Screening and Monitoring

• Annual ophthalmologic examination should begin after 5 years of treatment in patients without additional risk factors, or after 1 year in patients with CKD or other risk factors 2, 3, 1, 5.
• Retinopathy risk increases with duration, but remains <2% with proper dosing (≤5.0 mg/kg/day) for up to 10 years 1.

Pre-treatment and Ongoing Assessment

• Measure G6PD levels in men, especially those of African, Asian, or Middle Eastern origin, to assess hemolysis risk 6, 5.
• Establish baseline ophthalmologic examination and document baseline renal function (eGFR) 2, 3, 5.
• Regularly assess renal function, particularly in patients with pre-existing CKD, and monitor for rare adverse effects 2, 3, 6, 4.

Additional Benefits and Considerations

• Hydroxychloroquine reduces cardiovascular events and thrombotic complications, improves lipid profile, may have protective effects against infections, and allows reduction of corticosteroid doses 6, 4.